Bladder eversion
Introduction
Introduction to bladder valgus The valgus deformity of the bladder is found to have a different degree of abdominal wall defect in the middle of the lower abdominal wall after birth, resulting in the bladder being turned from the inside. In severe cases, the bladder is all valgus, the ureteral orifice is exposed on both sides, the pubic symphysis is defective, and severe urethral fissure is formed. basic knowledge The proportion of illness: 0.0003%-0.0005% Susceptible people: infants and young children Mode of infection: non-infectious Complications: hip dislocation spina bifida horseshoe kidney cleft palate anal atresia uterine prolapse
Cause
Cause of bladder valgus
(1) Causes of the disease
The cause of bladder valgus is currently thought to be due to errors in embryonic development, rather than a pause in development, since the development of human embryos usually does not go through the corresponding stage of bladder eversion.
(two) pathogenesis
The embryonic basis of bladder valgus deformity is the abnormal development of the cloaca membrane, hindering the mesoderm tissue to the middle, shifting the lower abdominal wall, and rupturing the rupture of the cloaca, forming various forms of bladder valgus and hypospadias.
Bladder valgus is mostly complex malformation. The common associated malformation is urethral fissure and cloaca valgus. Because the bladder and urethra are homologous in embryonic development, the most common compound malformation is bladder valgus-urethral crack.
In addition, some patients have only the developmental defects of the abdominal wall skeletal muscle, and the urethra development is complete. This condition is called pseudo-extraphysic; the main features are the umbilical cord is too long, the umbilicus is too low, and the rectal muscle is scattered. Attached to the pubis.
Prevention
Bladder valgus prevention
Early detection, early diagnosis, early treatment.
Complication
Bladder valgus complications Complications Hip dislocation Spinal fissure Horseshoe-shaped renal cleft palate Anal atresia Uterine prolapse
Infants with abdominal wall muscle abnormalities may be complicated by inguinal hernia; due to pubic symphysis separation, abnormal pelvic dysplasia of the femur or hip dislocation, the child is swinging gait while walking, children with bladder valgus may be accompanied by spina bifida, hoof Shaped kidney, rabbit lips, cleft palate, anal advancement, atresia, prolapse and other deformities.
Male pediatric penile corpus cavernosum development is poor, there are different degrees of urethral fissure, glans flat, foreskin accumulation in the ventral side, due to the separation of the corpus cavernosum and the penis upturn, so the penis is short, may be accompanied by cryptorchidism, female clitoris separation The anterior labial commissure is separated on both sides of the abdomen, the vaginal opening is advanced, fertile, and prolapse is easy after uterine prolapse. The long-term complications of bladder valgus are mainly vesicoureteral reflux, repeated infection of urinary system and stones. .
The anterior and posterior abdominal wall of the valgus bladder is deficient. The mucosal margin of the posterior wall of the bladder is connected to the skin of the abdominal wall. The entire posterior wall is swollen in the defect area of the abdominal wall. The exposed bladder mucosa is bright red, easy to bruise and hemorrhage, accompanied by severe pain. Because of chronic inflammation and long-term mechanical stimulation, the mucosal epithelium can be degenerated and even malignant. In the posterior wall, a slightly elevated ureteral orifice can be seen intermittently with urine. The urine often soaks the surrounding skin and causes dermatitis. Or eczema, most of the sick children died of urinary tract infection in childhood, almost all of the bladder valgus with urethral fissure and pubic symphysis, or with dislocation of the medullary joint.
Symptom
Bladder valgus symptoms common symptoms pubic symphysis separation urinary urinary odor scaly epithelium swing gait penis short eczema
Bladder valgus is rare, most children die in the urinary tract ascending infection in childhood, the child has partial defect in the lower abdominal wall, the valgus bladder mucosa is bare, the color is bright red, abnormally sensitive, easy to bruise and hemorrhage, showing bilateral convexity From the ureteral orifice, urinary urination, wet stains, urine odor, lower abdominal wall, perineum, dermatitis or eczema on the inner thigh skin, the size of the valgus bladder is very different, the valgus bladder mucosa is smooth early, due to long-term Exposure, mechanical friction to form villi, polyps or squamous metaplasia, the bladder wall thickens and hardens due to detrusor fibrosis.
Examine
Bladder valgus examination
1. Plain film: pelvic dysplasia, pubic symphysis completely separated, the width of the separation is about the same as the width of the tibia, so that the pelvis is open in a horseshoe shape, and the two bones are externally rotated.
2. Urography: The position of the bladder is reduced.
Should pay attention to accompanying malformation, do intravenous urography to understand the upper urinary tract, B-ultrasound examination of the kidneys, ureteral malformations, renal radionuclide scan, understand renal function, renal blood flow, conduct a comprehensive examination, understand cardiopulmonary function Is it normal?
Diagnosis
Diagnosis of bladder valgus
diagnosis
According to the symptoms of the child, the signs can be diagnosed:
1. Children's clothing wet stains, with urine odor, often swinging gait.
2. Part of the lower abdominal wall defect, bladder mucosa valgus, bright red, sensitive, easy to hemorrhage, double ureteral orifice exposed, burst urination, pubic symphysis separation.
3. Male infant with urethral fissure, short penis; baby girl clitoris, anterior labyrinth separation.
4. Accompanied by upper urinary tract or other organ deformities.
5. Exclude pseudo-ectal valgus, upper bladder or repeated eversion.
Pseudo bladder valgus: This is a complete urethral fissure plus bladder bulging, its umbilical hole is low, the rectus abdominis splits from the umbilicus, attaches to the separated pubis, and the bladder protrudes from the split rectus abdominis. But the urine is normal.
